Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality.

OBJECTIVE: Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them.

METHODS: Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality.

RESULTS: Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients.

CONCLUSION: An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care.

PRACTICE IMPLICATIONS: Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.